Billing & Claim Submission
This page is meant to help contracted Community Care providers seeking reimbursement for services provided to members.
Providers billing Community Care are required to use either a UB-04 claim or a standard CMS-1500 form. Community Care has provided links below to assist with submitting your billing. Please click on the link below that best describes your current billing situation or the type of services you provide.
If this is your first time billing with Community Care or to bill for general services, please click the link below:
For any questions or concerns please contact the provider hotline toll free at 1-866-937-2783 option "1" between the hours of 8 a.m. - 4:30 p.m. Monday through Friday (Central Time).
To learn more about Community Care's claim review process, please click on the link below:
Get paid faster by signing up for Electronic Funds Transfer. Use the links below:
E‐Form billing is a method of claims submission that should only be used by providers that are unable to submit professional electronic claims through a clearinghouse. To learn more about E-Form billing, please click on the link below:
Balance Billing of Community Care Members
Per CMS and your contract with Community Care, you can not balance-bill our members.
CMS published, as did the Social Security Act (referenced within these publications) regarding QMBs (Qualified Medicare Beneficiaries).
In Summary:
- All our dual eligible members in PACE, Partnership and Family Care are QMBs
- Federal law prohibits providers from billing QMBs for Medicare deductibles, coinsurance, or copays for any Part A or Part B service (see Sections 1902(n)(3)(B), 1902(n)(3)(C), 1905(p)(3), and 1848(g)(3)(A) of the Social Security Act [the Act])
- In states that have adopted a lessor of pay policy such as Wisconsin the state may limit their payment to the difference between the Medicaid rate and the amount Medicare has already paid which may result in no Medicaid payment if the Medicare paid amount is greater than the Medicaid allowed amount
- QMBs cannot elect to pay any Medicare deductibles, coinsurance, or copays
Billing for Medical Service Providers
For medical service providers: Community Care will only accept and process claims received electronically through a clearinghouse. In addition, we will only send you electronic remittances (ERA 835) and only issue payment via electronic funds transfer (EFT).
- Frequently Asked Questions on electronic billing and remittance (PDF)
- CCI Mapping to RARC (PDF)
- Skilled Nursing Facility Quick Billing Reference Manual (PDF)
Change Healthcare is LIVE
Community Care, Inc. (CCI) has resumed connectivity with Change Healthcare for electronic claim submission and Electronic Remittance (ERA) transactions.
Providers may now use Change Healthcare to submit claims and receive remittance files.
Update: Electronic Claim Submission
Providers are required to submit claims electronically through a clearinghouse.
We understand that many providers were unable to submit claims and receive remittances through a clearinghouse due to the Change Healthcare cyberattack in February and the requirement to submit claims electronically was temporarily waived. Now that connectivity is restored, providers are required to submit all claims electronically through one of our partner clearinghouses: Change Healthcare or Office Ally. Providers will need to make this transition by August 15th, 2024. Paper claims received on/after this date could be rejected.
Change Healthcare
You can resume submitting claims electronically through Change Healthcare, as you did before the cyber-attack.
Office Ally
If you are setup to submit claims to CCI through Office Ally and want to continue in this manner, no change is necessary for electronic claim(s) submission.
Update: Receiving ERA/835s
Change Healthcare
NEW- Community Care will now automatically send ERAs to Change Healthcare if you submit your claims electronically through them. Providers that submit claims electronically through Change Healthcare will be auto-enrolled for ERAs. It is important that you work with your clearinghouse to confirm they have a connection with Change Healthcare and that they are retrieving your remittance files. Your clearinghouse will provide you with instructions on how to locate the remittance files.
Note: ALL remittance files that were held as the result of the cyber security attack have been transmitted to Change Healthcare. Please work with Change Healthcare and/or your clearinghouse to retrieve these files.
Office Ally
Community Care automatically sends the ERAs to Office Ally if you submit your claims electronically through them. It is important that you work with your clearinghouse to confirm they have a connection with Office Ally and that they are retrieving your remittance files. Your clearinghouse will provide you with instructions on how to locate the remittance files.
